Trillian's Depression Page

Cyclothymia

Click here to read the criteria for Cyclothymic Disorder from the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-IV).

Click here to read the ICD-10 Classifications for Cyclothymic Disorder, from the World Health Organization.

Cyclothymia is characterized by pronounced but not debilitating shifts of moods often lasting approximately two to nine weeks.

Results in family studies support the idea that at least a fraction of "cyclothymia" is a mild or subclinical form of bipolar disorders.

Cyclothymia is similar to bipolar disorder since it is characterized by mood swings from mania to depression. However, there are several important differences between the two.

A person with cyclothymia experiences symptoms of hypomania but never a full blown hypomanic episode. Likewise, while depression is a facet of cyclothymia, the symptoms are never severe enough to be classified as a major depressive episode.

While a person with cyclothymia is not likely to end up in the hospital, the intense mood swings may seriously disrupt one 's life. Imagine feeling on top of the world, ready to take on any project one day, just to wake up the next morning feeling down, depressed and blue. This is what it 's like living with cyclothymia.

Diagnosis:

For cyclothymia to be diagnosed, hypomanic symptoms and depressive symptoms must be present alternately for at least two years. Mood swings seem to occur frequently in people with cyclothymia -- the switch from depression to hypomania and back again may occur every few days or weeks -- even every few hours in extreme cases! Mood swings are consistent; a person with cyclothymia is never symptom-free for longer than two months.

Diagnosis Criteria:

At least two years of numerous Hypomanic Episodes (one year for children and adolescents). Hypomanic periods had predominantly elevated mood, expansive mood, or irritable mood.

During these hypomanic periods had at least 4 of the following:

• Inflated self-esteem or grandiosity
• Decreased need for sleep
• More talkative than usual or pressured speech
• Flight of ideas or racing thoughts
• Distractibility
• Increase in goal-directed activity or agitation
• Reckless involvement in pleasurable activities
• Absence of evidence that these hypomanic periods caused marked occupational or social impairment

Mood was never normal for more than 2-months at a time during this 2-year hypomanic period (or during one year for children and adolescents). Absence of a Major Depressive Episode or Manic Episode during the first 2-years of this hypomanic period (or during one year for children and adolescents).

Absence of two weeks or more of delusions or hallucinations when mood was normal. Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified. Absence of evidence that an organic factor initiated and maintained this hypomania and depression

Treatment:

Medical Treatment:

Biomedical treatment of cyclothymic disorder should be empirically derived and should be offered only if the individual's functioning is significantly adversely affected.

Lithium

A trial of lithium carbonate may ameliorate manic symptoms and reduce the frequency of most cycles. If the relatively mild mood swings of Cyclothymic Disorder are considered an attenuated form of bipolar disorder, then lithium is a logical treatment of choice (except for specifically depressive symptoms). Unfortunately, controlled research with lithium in specifically diagnosed cases of Cyclothymic Disorder is lacking.

Psychosocial Treatment

Even with successful drug treatment, many patients with this disorder will benefit from psychotherapy that focuses on interpersonal relationships and self-image.

A number of authors consider such patients to be suffering more from character pathology (e.g., narcissistic, histrionic, or borderline traits) than from an affective disorder. From this point of view, particularly if the mood swings are responses to small changes in the patient's physical or emotional environment, psychotherapy or environmental manipulation may be more helpful than medication.

Individual Psychotherapy

There are reports of occasional attempts at psychotherapy, particularly long-term psychotherapy, with cyclothymic disorder, but no systematic studies are available.

Mild cases of cyclothymia are often treated with therapy alone. For more severe cases involving periods of intense hypomania, Lithium may do the trick. Antidepressants are a treatment option, but if a person has depression severe enough to need medication therapy, they probably will be diagnosed with bipolar disorder, not cyclothymia.

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